Ezra Klein sees the writing on the wall

Ezra Klein of the Washington Post made his name by being (or at least posing as) a liberal health care wonk. Klein’s pronouncements on the subject have often been wide of the mark, but he is spot on with his 12 propositions about the trouble Obamacare now finds itself. Here are the highlights:

1. The Affordable Care Act’s political position has deteriorated dramatically over the last week. President Bill Clinton’s statement that the law should be reopened to ensure everyone who likes their health plans can keep them was a signal event. It gives congressional Democrats cover to begin breaking with the Obama administration.

2. The most serious manifestation of that break is Sen. Mary Landrieu’s “Keeping the Affordable Care Act Promise Act.” It’s co-sponsored not just by the usual moderate Democrats — Landrieu and Dianne Feinstein and Mark Pryor and Kay Hagan — but also by Oregon liberal Jeff Merkley. It’s worth noting that Merkley is up for reelection in 2014.

3. The argument Landrieu is making on behalf of the bill will appeal to many Senate Democrats. “When we passed the Affordable Care Act, we did so with the intention that if you liked your health plan, you could keep it,” she said on the Senate floor. “A promise was made and this legislation will ensure that this promise is kept.”…

4. The bill Landrieu is offering could really harm the law. It would mean millions of people who would’ve left the individual insurance market and gone to the exchanges will stay right where they are. Assuming those people skew younger, healthier, and richer — and they do — Obamacare’s premiums will rise. Meanwhile, many people who could’ve gotten better insurance on the exchanges will stay in bad plans that will leave them bankrupt when they get sick.

5. Put simply, the Landrieu bill solves one of Obamacare’s political problems at the cost of worsening its most serious policy problem: Adverse selection. Right now, the difficulty of signing up is deterring all but the most grimly determined enrollees. The most determined enrollees are, by and large, sicker and older. So the Web site’s problems are leading to a sicker, older risk pool. Landrieu’s bill will lead to a sicker, older risk pool. Obamacare has provisions meant to stop an out-of-control death spiral, but higher premiums are a real danger.

6. How much will premiums rise if Landrieu’s bill passes? No one knows….

8. Insurers would. . .freak out. “Some insurers would end up pulling out [of the exchanges] for 2014 because they would say their premiums are now inadequate, and the rules have changed,” said Larry Levitt, vice president at the Kaiser Family Foundation. They’d be right, of course.

9. Nor is it clear, if the Landrieu bill passes, that that’s the end of it. . . .Once Congress reopens Obamacare, no one knows where they stop. Landrieu’s bill, for instance, will also have to pass the House — and they’re going to want to attach provisions to it that Democrats won’t much like….

11. The biggest problem for the Obama administration in protecting the law is that they’re losing credibility with congressional Democrats — and, frankly, everyone else. They passed the law based in part on promises they couldn’t keep. They botched the implementation terribly. And now it looks like they may not have HealthCare.gov fixed by the deadline they set for themselves. Congressional Democrats feel burned by them — but even worse than that, they don’t feel able to trust them….

12. Ultimately, the White House needs to be able to convince congressional Democrats that their best chance in 2014 is a working law. Solving a political problem now at the case of worsening a policy problem 10 months from now isn’t a good trade. But they can’t do that unless congressional Democrats are confident that the White House can make the law work.

Klein’s piece looks, in part, like an attempt to rally the troops against “Keep Your Plan” legislation. But as I said this morning, the panic instinct is difficult to resist.